Project Summary More than 415,000 children live in foster care in the US, 58% of whom are racial and ethnic minorities, a rate that is disproportionate compared to the general population. As many as 40% of children entering foster care have special healthcare needs, and when foster placements change, children live with new caregivers and change primary care and subspecialty healthcare providers. Often these transitions are not coordinated, resulting in gaps in healthcare and poorer health. Teens in foster care are at even greater risk because they spend more time in foster care, experience placement instability, and age out of foster care without an adult to assist them with navigating the healthcare system. As a result, teens in foster care report being disconnected from primary and non-emergency healthcare, and experience poor health well into adulthood. While the risks for poor life-long health are clear, patterns of healthcare utilization and types of healthcare services accessed by teens in foster care are not known. Further, it is unclear what impact foster care placement instability has on healthcare utilization while teens are in foster care. It is critical to understand patterns of healthcare utilization for youth while they are in foster care so that healthcare providers and systems can anticipate and optimize the services foster youth receive and begin to address significant health disparities for these vulnerable youth. This study draws on secondary data analysis of administrative child welfare records of children ages 16-21 in foster care between 2012 and 2016 from a single county in Ohio. Data have been linked to electronic medical records to provide a retrospective medical and social history for 1,023 foster youth, with a mean age of 18. Foster youth will be matched to 1023 youth without foster care experience. Half (52%) of youth are women, and 78% are minorities. Healthcare utilization will be assessed by examining healthcare days ? the number of days per month that teens encounter the healthcare system. Healthcare days serve as a proxy for healthcare expenditures (e.g., cost of primary care visit) and loss of productivity (e.g., time away from school or work) for youth and caregivers, which have social and economic costs. The study has three aims. Aim 1: Determine the impact of mandated healthcare visits and placement changes on existing patterns of healthcare use, and isolate the impact of repeated placement changes on long-term shifts in patterns of use among foster care youth. Aim 2: Determine the effects of patient characteristics, resources, and need on healthcare utilization for adolescents who are in foster care. Aim 3: Identify differences in the effects of patient and environmental characteristics that lead to healthcare days for youth who are and are not in foster care, examining total, scheduled, unscheduled and unattended scheduled healthcare days per month. Additional analyses will examine the unique contribution of minority status on placement disruptions and patterns of healthcare use, as minority youth are more likely to experience placement changes and have poorer educational, occupational, and health outcomes.